Provider Demographics
NPI:1447900253
Name:LCDA LEZLIE LOPEZ DIETISTA - NUTRICIONISTA
Entity type:Organization
Organization Name:LCDA LEZLIE LOPEZ DIETISTA - NUTRICIONISTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEZLIE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:939-585-4321
Mailing Address - Street 1:HC 3 BOX 31220
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-9515
Mailing Address - Country:US
Mailing Address - Phone:939-585-4321
Mailing Address - Fax:
Practice Address - Street 1:CARR. 665 KM. 1.4 BARRIO TOSAS
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650-9515
Practice Address - Country:US
Practice Address - Phone:939-585-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty